Less-invasive technique repairs life-threatening condition


A patient who underwent a less-invasive technique to repair an arteriovenous fistula was able to return to work just two weeks after surgery.

What enabled the patient, Bill Abt to recover so quickly and painlessly was a less-invasive surgical technique performed by Loyola University Medical Center neurosurgeon William W Ashley, Jr.

The less-invasive technique Ashley performed was an endovascular treatment. He inserted a catheter in an artery in the groin, then guided the catheter up past the heart and through the carotid artery into the brain. Once the catheter reached the fistula, Ashley injected a liquid polymer that immediately solidified. This effectively sealed off the fistula to prevent a possible rupture.

The case began when Abt consulted a physician about tinnitus (chronic ringing in his ear). The physician ordered a scan, which detected the arteriovenous fistula.

Normally, arteries and veins are separate, with arteries transporting high-pressure blood from the heart to the body’s organs, and veins carrying low-pressure blood back to the heart. But in Abt’s case, an artery in his brain was directly connected to a vein. Consequently, high-pressure blood was shooting into the vein — like a fire hose connected to a garden hose. The thin-walled vein, not designed to withstand such pressure, ballooned outward and was at risk of rupturing. Blood leaking from such a rupture could have caused a debilitating or fatal stroke.

Christopher Loftus, chair of the Department of Neurological Surgery presented the case to a multidisciplinary cerebrovascular conference. Loftus led the discussion as physicians carefully examined the risks and benefits of all options, including traditional open surgery, the less-invasive endovascular treatment or no treatment at all. Loftus decided to bring Ashley in on the case.

Abt underwent the less-invasive endovascular treatment on a Friday. He went home the next day, and began working from home the following week. The second week, he returned to work as senior vice president for administration and business at Carthage College in Kenosha, USA.